I am a school nurse and have a second grader who has started banging his head on the concrete walls, table, and other surfaces enough to leave red marks. We are wondering what he could possibly be doing to himself over the long term. He is emotionally disturbed and autistic. Should he be checked for possible traumatic brain injury? How can we help him?
There is no easy answer to your question. First, I would have him seen by his pediatrician for a thorough check-up and review his medical history to see if has had any previous falls or concussions. The next step would be to try to figure out what has precipitated this new head banging behavior. Typically developing children usually do not intentionally bang their heads hard enough to cause injury — but it's an effective behavior to get an adult's attention. For this child though, we can’t count on his ability to regulate himself even when a significant level of pain is involved.
The first priority is to keep him safe. That means not allowing him to hurt himself. A thorough assessment of his behavior should lead to a plan to reduce the head banging. In the meantime, he may need other interventions that might include protective headgear or medication. If a neuropsychologist or a behavioral psychologist is not involved in his care, you might consider a referral to help you figure out how best to manage this difficult and concerning situation.
Gerard Gioia, PhD is a pediatric neuropsychologist and the chief of the Division of Pediatric Neuropsychology at Children's National Medical Center. He is an associate professor of Pediatrics and Psychiatry at the George Washington University School of Medicine.